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Lazarow F, Deal AK, Shaves SC, Knapp B, Byars D, Goodmurphy CW, Trace AP, Nunez D, Elzie CA. Evaluation of a point-of-care ultrasound curriculum and ocular phantom in residency training. J Ultrasound 2022; 25:259-263. [PMID: 33797736 PMCID: PMC9148320 DOI: 10.1007/s40477-021-00578-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Specialized training in ocular ultrasound is not a focus for most emergency medicine residencies, despite the fact that it allows physicians to quickly and accurately identify ocular pathology and prioritize emergency ophthalmological consultations. Therefore, we tested the value of utilizing normal and pathologic ocular ultrasound phantoms as a training tool for residents. Twenty emergency medicine residents were given a pre-test including written and practical skills diagnosis of ocular phantom pathologies, a short video on common ocular pathologies, practice time with the phantoms and a post-test including written and scanning components. Residents were then asked to complete an overall evaluation of the learning activity. After didactic and hands-on training with phantoms, residents demonstrated a significant increase in knowledge, skills and preparedness for diagnosing real patients with ocular pathologies. Overall, the phantoms allowed residents an unrestricted opportunity to practice and refine their technique. This study provided a framework for teaching emergency medicine residents the basics of ocular US through a brief didactic and practical intervention using novel ocular pathology US phantoms. Our curriculum resulted in both objective and subjective improvement in residents' performance and understanding of ocular US.
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Affiliation(s)
- Frances Lazarow
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA USA
| | - Anna K. Deal
- Department of Emergency Medicine, Eastern Virginia Medical School, 600 Gresham Drive, Suite 304 Raleigh Bldg, Norfolk, VA 23501 USA
| | - Sarah C. Shaves
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA USA
| | - Barry Knapp
- Department of Emergency Medicine, Eastern Virginia Medical School, 600 Gresham Drive, Suite 304 Raleigh Bldg, Norfolk, VA 23501 USA
| | - Donald Byars
- Department of Emergency Medicine, Eastern Virginia Medical School, 600 Gresham Drive, Suite 304 Raleigh Bldg, Norfolk, VA 23501 USA
| | - Craig W. Goodmurphy
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
| | - Anthony P. Trace
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA USA
| | - David Nunez
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA USA
| | - Carrie Ann Elzie
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
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Khoo SA, Ong GYK. Use of Ocular Point-of-Care Ultrasound in a Difficult Pediatric Examination: A Case Report of an Emergency Department Diagnosis of Retinoblastoma. J Emerg Med 2020; 58:632-635. [PMID: 32204994 DOI: 10.1016/j.jemermed.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 01/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Eye examination in distressed young children can be challenging in a busy emergency department. A full, detailed evaluation is, however, often needed in ocular emergencies. CASE REPORT A 2-year-old boy presented to our pediatric emergency department with refusal to open his left eye for 1 day. Eye examination was difficult and yielded limited findings, despite analgesia and parental facilitation. Under such circumstances, this might require sedation or forcibly everting the child's eyelids for the eye evaluation. A rapid ocular point-of-care ultrasound was performed, which revealed sonographic findings suggestive of a retinoblastoma in the left eye. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The use of ocular point-of-care ultrasound facilitated the diagnosis of retinoblastoma in a child who was highly distressed and difficult to examine. Its use under such circumstances facilitated the patient's prompt evaluation and subsequent management.
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Affiliation(s)
- Su Ann Khoo
- Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore
| | - Gene Yong-Kwang Ong
- Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore
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Beyond Point-of-Care Ultrasound: Bedside Ultrasound in the Diagnosis of Soft Tissue Mass. Pediatr Emerg Care 2020; 36:112-117. [PMID: 31842201 DOI: 10.1097/pec.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cancer is diagnosed in 1 in 7000 children annually. Here, we report 6 cases of a mass identified by the author, a novice sonographer in a pediatric emergency medicine fellowship, using point-of-care ultrasound, from January of 2017 to May of 2018. Identification of these cases early in presentation allowed for earlier involvement of the relevant specialist and shorter time to diagnosis and treatment, and might be expected to increase parent satisfaction as well.
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Abstract
OBJECTIVE Point-of-care ultrasound has become an important adjunct for diagnostic assessment in pediatric emergency medicine. In this case series, we demonstrate how ocular point-of-care ultrasound is used to correctly diagnose ocular pathologies and to expedite care. METHODS/RESULTS We present a series of cases in which the point-of-care ultrasound ocular examination proved valuable in the timely diagnosis of pathologies involving the lens, vitreous, retina, and retrobulbar segment of the eye. CONCLUSION Point-of-care ultrasound may facilitate diagnosis in children with ocular complaints, even in young and uncooperative patients, and should be considered in children of all ages.
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Abstract
An 18-month-old girl presented to the emergency department with the chief complaint of squinting. The right eye demonstrated esotropia, heterochromia, and anisocoria. Ocular point-of-care ultrasound facilitated the rapid diagnosis of retinoblastoma, which was confirmed by computed tomography scan and orbital magnetic resonance imaging.
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Gonzalez LK, Yellin S, Arroyo AC. Point-of-Care Ultrasound in the Pediatric Emergency Department: Where We're at, Where We're Going. Adv Pediatr 2018; 65:121-142. [PMID: 30053920 DOI: 10.1016/j.yapd.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura K Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA
| | - Sharon Yellin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA
| | - Alexander C Arroyo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA.
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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Sonographic Detection of Unilateral Retinoblastoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316650871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retinoblastoma is a cancer that affects the eye, and if untreated, it can spread to other parts of the body. Retinoblastoma is the most common pediatric eye cancer and accounts for 3% of all childhood cancers. It can be hereditary or sporadic (nonhereditary). This case study presents a unilateral retinoblastoma of the right eye in a pediatric patient. A diagnosis of retinoblastoma was made by correlating sonography, magnetic resonance imaging, and ophthalmology. Treatment for retinoblastoma depends on the severity of the cancer but can include radiation, chemotherapy, focal laser therapy, and/or surgery. This particular case of retinoblastoma was treated with chemotherapy.
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Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016; 21:294-311. [PMID: 26683523 DOI: 10.1111/tmi.12657] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used. METHODS The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions. RESULTS A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials). CONCLUSIONS Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.
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Affiliation(s)
- Dawn M Becker
- Department of Internal Medicine, St. Joseph Mercy Hospital Ann Arbor - St. Joseph Mercy Health System, Ann Arbor, MI, USA
| | | | - Sören L Becker
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
| | - Grant H Kruger
- Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Torben K Becker
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Ophthalmic sonography has been practiced for more than 50 years, but it is not an area of sonography that is familiar to many physicians and sonographers. However, it can be very helpful as a means to noninvasively evaluate for specific anomalies and also assist in cases of trauma. This article has been written to describe ocular sonography and its clinical capabilities in a wide variety of settings, from an individual physician office to a busy emergency department.
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